The opioid epidemic is creating heightened risk for outbreaks of HIV and hepatitis C, largely due to increased injection drug use. This isn't just theoretical. The most notorious recent case linking HIV to injection drug use occurred in Scott County, Indiana, where in early 2015, officials discovered an outbreak that ultimately resulted in 210 cases of HIV diagnosed in a town of 2,400, and 90% of those were co-infected with hepatitis C. Late last year, the Centers for Disease Control & Prevention (CDC) identified 220 other counties across the U.S. that are at high risk for a spike in new HIV infections due to injection drug use.

What Is Meth?

Methamphetamine is a synthetic drug created by combining pseudoephedrine with many other chemicals, such as acetone, ammonia, and phosphorus. Meth, like other stimulants, works primarily by blocking dopamine receptors in the limbic or reward circuitry of the brain. This very old part of our biology gives bursts of pleasurable rewards via dopamine in response to activities that reinforce our survival as a species. Such "natural" rewards are triggered by food, bonding, collaboration, and most powerfully, orgasm. Stimulants hijack this system by blocking dopamine receptors, causing neurotransmitters to flood the synapse between nerve cells and create an explosion of pleasurable feeling.

There are differences between meth and cocaine. Cocaine blocks the receptors for and reabsorption of dopamine, thus creating a euphoric state for a relatively short period, about 15 to 20 minutes. Methamphetamine is, on the other hand, a synthetic drug that blocks dopamine receptors for periods as long as eight to ten hours. During this time, a great deal of dopamine is not only blocked from reabsorption but also flushed out of the nerve cells, creating (at least initially) a burst of good feeling followed by a devastating crash in mood, sometimes called "suicide Tuesdays" by users who experience severe depression after a weekend of partying. Methamphetamine differs from cocaine in one other way: it is neurotoxic, meaning that it ultimately destroys the dopamine receptor itself. With consistent use, such injury severely impacts the brain's ability to regulate dopamine, resulting in mood fluctuations, impulsivity, and severe drug cravings. These damaged dopamine pathways will regenerate, but that process can take up to 24 months. And, compared with cocaine abuse, meth overdoses more frequently result in stroke, heart attack, psychosis, and other complications.

Despite these harmful effects, many different kinds of users continue to ingest methamphetamine. Long-haul truckers and workers in tedious jobs use meth for wakefulness and concentration; many, especially women, use meth for weight loss and appetite control; and a significant number of gay, bi, and trans men use meth to enhance sexual experiences.

Dangerous Trends

Epidemics of drugs tend to rise and fall, but the latest meth epidemic, which began around 2000, shows no signs of slowing down. One reason is the unintended consequences of a federal law called the Combat Methamphetamine Epidemic Act of 2005, which limited sales of the precursor pseudoephedrine. This put local, so-called mom and pop meth labs out of business and created an opening for a new supply source that was rapidly filled by Mexican drug cartels. They have been flooding the U.S. with methamphetamine that is extremely high in purity and cheaper in price ever since.

At the same time, meth use is expanding into different communities. Traditionally, gay, bi, and transgender men using meth were urban and white and accounted for the majority of meth users at risk for HIV. Now, researchers and clinical programs are documenting increased numbers of black and Latinx meth users. Among black MSM in Washington, D.C., for example, data from the National Behavioral Health Survey showed a significant increase in meth use among venue-attending black MSM from 2008 to 2014, and a corresponding decrease among white MSM during the same period. This phenomenon is also explored in the important documentary ParTy Boi, Black Diamonds in Ice Castles. In these minority communities, the meth epidemic has now merged with the HIV epidemic to create a dangerous new syndemic that is fueling high rates of HIV.

Meth intersects with HIV in several ways: It increases risk for HIV by heightening sexual desire while at the same time reducing good judgment and impulse control. Many men and women ingesting meth find themselves practicing unprotected, receptive anal intercourse, the highest-risk sexual act. Meth also significantly impacts medication adherence, opening the door to antiretroviral drug resistance. Finally, there are drug interactions between meth and boosters such as Norvir (ritonavir) or Tybost (cobicistat). Such drugs elevate blood levels of drugs in the antiretroviral regimen, and they significantly boost levels of methamphetamine, as well.

Here are some important tips if you or someone you care about is struggling with methamphetamine:

Harm Reduction
Many meth users ultimately ingest methamphetamine intravenously. This significantly increases risk of HIV, hepatitis C, and other medical complications. While stopping meth is the best option, certain precautions will reduce harm for those who continue to use. These include using clean drug paraphernalia, never sharing equipment, and wound care for any missed injection sites -- including seeking medical attention if the site gets swollen, red, or warm to the touch. More guidelines can be found here.

Emergency Care
Given the high purity of meth on the streets today, it is essential to be alert for possible complications of meth overdose. Signs can include cardiac complications, stroke, and psychosis. Because paranoia is a common feature of meth-induced psychosis, it is important to take steps to maintain safety for the user, which may include emergency medical treatment. There is unfortunately no methamphetamine equivalent of Narcan, the drug that reverses opioid overdoses.

Treatment
Because meth recovery typically involves numerous relapses, there is a certain mythology that it is impossible to recover from this drug. This is absolutely not true, although the road to abstinence can be long and difficult. Meth creates numerous cues and triggers that elicit very strong cravings for the drug. In most cases, meth users find that they need the intervention of treatment professionals both to manage these cues successfully and to support their recovery. A guide to substance abuse treatment facilities can be found here.

We have faced many dangerous drug epidemics, but the consequences of dealing with two powerful waves of drug use that directly impact the risk of HIV demand our immediate attention and intervention.

David Fawcett, Ph.D., LCSW, is a substance abuse expert, certified sex therapist and clinical hypnotherapist in private practice in Ft. Lauderdale, Florida. He is the author of Lust, Men and Meth: A Gay Man's Guide to Sex and Recovery.

(Please note: Your name and comment will be public, and may even show up in Internet search results. Be careful when providing personal information! Beforeadding your comment, please read TheBody.com's Comment Policy.)

Please do not modify the following input field.

Your Name:

Your Location:

(ex: San Francisco, CA)

Your Comment:

Characters remaining:

Advertisement

The content on this page is free of advertiser influence and was produced by our editorial team. See our advertising policy.

The Body is a service of Remedy Health Media, LLC, 750 3rd Avenue, 6th Floor, New York, NY 10017. The Body and its logos are trademarks of Remedy Health Media, LLC, and its subsidiaries, which owns the copyright of The Body's homepage, topic pages, page designs and HTML code. General Disclaimer: The Body is designed for educational purposes only and is not engaged in rendering medical advice or professional services. The information provided through The Body should not be used for diagnosing or treating a health problem or a disease. It is not a substitute for professional care. If you have or suspect you may have a health problem, consult your health care provider.